Sunday, 26 July 2015

In my last post I link to a newspaper article featuring a young man who tragically died of hypoxia after inhaling pure nitrous oxide. The article emphasises that this was a consequence of substance abuse. However there is another situation where theoretically exactly the same situation could arise in what is perceived as a much more harmless practice.

Helium balloons are widely bought both for adults and children. How many people, including children, have opened the balloon and inhaled the gas to produce an amusing squeaky voice? There's no oxygen in them either.

DZ is fond of browsing in old bookshops. In particular he likes medical textbooks from the 1920s and 30s, and autobiographies of doctors who worked at the time. It's fascinating to read about some of the things we used to do to people.

For example. I found an old textbook of anaesthesia, in which was described the "nitrous oxide jactitation technique" of starting anaesthesia.

Apparently what you did was this. You put a mask on the patient's face and administered 100% nitrous oxide. That is, no oxygen. None at all. Unsurprisingly, in a very short time the patient became blue, and unconscious. The anaesthetist (who at that time was likely to be the surgeon's houseman) continued to administer 100% nitrous oxide until the patient exhibited a phenomenon known at the time as "jactitation". What is known today as a hypoxic fit! The houseman would only then switch in oxygen, and ether, and all was well. Apparently.

It sort of puts in perspective the panic you see in today's anaesthetists when the saturation drops below 90%.

I've mentioned this technique to a number of anaesthetists and only one (older generation) had ever heard of it. He assures me that the technique was still used, mainly by dentists, right into the 1960s.

The practice now seems to be making something of a comeback. You'd think wouldn't you that if people were going to sell N2O for recreational purposes that it might be a good idea to put some O2 in. Just 20% would do

Thursday, 23 July 2015

DZ very rarely buys fast food. But once in a while he finds himself hungry enough to eat a raw scabby cat with the fur on, and finds no alternative. And so recently he found himself in a Burger King where he he enjoyed this exchange with a young lady behind the counter.

We all know that finding beds for emergencies can be a problem. And that part of the problem is that many elderly patients occupy beds when they no longer need hospital care, but there is nowhere to send them. Nursing home beds seem to be in short supply too. But I had no idea how desperate the shortage of nursing home beds actually was till I saw this.

Saturday, 11 July 2015

In his time DZ, in common with just about all hospital specialists, has done a little research. My own feeling is that the insistence that some research appearing on a CV is an absolute necessity for career progression is misplaced. Forcing the disinterested to do research can only produce poor quality research, and dilute resources, starving those who really want to do it, and produce good quality stuff.

But that's not what I'm going to explore today.

Imagine for a moment DZ does a research project. He collects the measured data and does the analysis. And gets results entirely unexpected and counter intuitive. His natural reaction is to doubt the data. So what does he do? Does he, doubting his results, submit what he actually found, or does he throw it in the bin and start again? Either would be acceptable ethically. But there's a third option. What if he looks at the data, and alters it, so that it supports his preconceptions? What if he tweaks the data here and there so that the results are completely altered to conform with what he expected to find?

In medicine that would rightly be called "falsification" or "fraud". If found out my paper, if published, would be redacted and my reputation destroyed. I might well lose my job, and have to answer to the GMC. And quite right too. Research fraud is a serious matter.

The point of research is to observe nature. The data you collect is sacrosanct. If you find you've made an error you can discard it, but you can't just alter it. Your measurements should be inviolable, whether you like them or not.

Altering your data is just not acceptable or excusable. Even worse is when you admit the fraud and try and sanitise it by calling your falsifications "adjustments". Present your data, like it or not unadjusted. Don't piss down my back and tell me it's raining.

Thursday, 2 July 2015

Prior to 1987 child sex abuse did not
exist. At least in the minds of the general public, successive
governments and the medical profession, it didn't exist. In reality
of course it was widespread. Also in reality great efforts were made
to ignore it and suppress any mention of it. In his autobiography
“This time next week” the author Leslie Thomas, orphaned during
the war, describes how widespread it was in Barnardo's homes. It was
ignored. When cases come to light now about child sex abuse prior to
1987, featuring various individuals, it is extraordinary how many
people knew what was going on. Also extraordinary were the efforts
made to keep it all brushed under the carpet. This enabled predators
such as Saville to act, unimpeded, for years. And it allowed
institutions such as the catholic church to facilitate the actions of
the numerous paedophiles within it's ranks.

In 1987 all this changed. In that year
two paediatricians at a Middlesborough hospital, Dr Marietta Higgs,
and Dr Geoffrey Wyatt, reported 121 cases of child sex abuse to
social services over a period of 4 months. Now, in retrospect, it is
clear that the diagnosis was correct in the majority of cases. But at
the time it was something society just didn't want to hear. There was
a huge outcry. The two doctors were widely vilified, especially in
the Daily Mail. Like other whistleblowers before and since they were
turned on and viciously attacked. A government report, published a
year later was a whitewash. Many abused children were returned to
abusive households.

But the genie was out of the bottle.
Society had now been forced to address an issue it would prefer to
have ignored.

In 1994 Dr Higgs' employers found
themselves in a dilemma. Due to the adverse publicity they felt that
Dr Higgs position in Middlesborough was untenable, and that they
could no longer allow her to work there. However she had actually
done nothing wrong, so could not be dismissed. Their solution was to
move her to the Queen Elizabeth Hospital in Gateshead, to take up a
position as a neonatologist, with no duties related to child sex
abuse. Dr Higgs was well respected within paediatric circles in the
area, and the paediatric consultants in Gateshead were unanimous in
welcoming her.

The rest of the Consultant body at
Gateshead were not so welcoming. There was an immediate outcry among
them, and strong opposition to the appointment expressed. At a bad
tempered meeting of the senior staff committee the Paediatricians
were openly berated and abused, in a shameful and disgusting display
of mob mentality, led by a consultant general surgeon, coincidentally
also called Higgs, though not related to Marietta. All they lacked at
the meeting was pitchforks. A motion was proposed to demand of
management that Ms. Higgs not be allowed to work at Gateshead. In a
secret ballot on the motion only one non paediatric consultant voted with the
paediatricians and against the mob. The appointment went ahead anyway.

Not just the medical profession but the
whole of society owes Marietta Higgs a debt of gratitude that has
never been acknowledged. She forced a society that didn't want to
know to accept that child sex abuse did not just exist, but was
common.. She prised open the unwilling eyes of society to an evil
that it did not want to see. As a result of this the Children's Act
was passed in 1998. Once the problem was acknowledged, only then
could it be addressed, and to this day historic child sex abuse cases
continue to be unearthed, often involving high profile individuals.
Children in the UK, and arguably beyond, are safer today because Drs
Higgs and Wyatt had the courage of their convictions.